Healthcare Provider Details

I. General information

NPI: 1013077205
Provider Name (Legal Business Name): BRUCE A PETITT M.D. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 12/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 FAIRFAX PARK SUITE C
TUSCALOOSA AL
35406-2806
US

IV. Provider business mailing address

1060 FAIRFAX PARK SUITE C
TUSCALOOSA AL
35406-2806
US

V. Phone/Fax

Practice location:
  • Phone: 205-752-7337
  • Fax: 205-752-8013
Mailing address:
  • Phone: 205-752-7337
  • Fax: 205-752-8013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BRUCE A PETITT
Title or Position: PHYSICIAN OWNER
Credential: M.D.
Phone: 205-752-7337